Why does my evening meal keep making my blood sugars unstable?

[Introverted_And_Proud]

So, this is a bit of a weird one that I've been dealing with for a while now. Not sure if anybody could help me with it, but figured it was worth a shot. For context, I am a Type 1 diabetic who uses Novorapid and Tresiba insulin. I also suffer with IBS-C (this is semi-relevant).

Two days a week, I always eat the same evening meal: fresh stir-fry chicken (0g of carbs) with 200g of Aunt Bessie's roast potatoes (36g of carbs) and 100g of frozen bag broccoli (3g of carbs). When I inject for this meal, I always do it right before eating. And every single time, within 30 minutes to an hour of injecting, my blood sugar levels will drop continuously, usually for up to an hour in some cases. Sometimes, my levels will stop above 4mmol - 5mmol, then slowly start to rise until they reach high levels by the time I go to bed. Other times, however, my levels will go below 4mmol, forcing me to take hypo treatment. The hypo treatment kicks in quickly within 10 to 15 minutes and puts my levels in the green. But from there they keep rising and wind up going too high after around two hours have passed.

Now, the strangest thing is this is the only meal where I have this particular problem. The other evening meals I eat throughout the week never do this. My levels are usually quite stable with them. And some of the foods I've listed above I also eat with other evening meals (i.e. broccoli and potatoes), yet they haven't caused the same issue. Furthermore, I don't think this is being caused by me accidentally injecting into a muscle. I admit I am underweight for my age and have minimal body fat, but I don't usually feel any pain or bleed when I inject. So, this has certainly left me scratching my head and looking over my Libre data to try to figure out the cause behind this strange pattern.

I came up with the following theories:

Maybe I'm injecting too much insulin?

Could it be my digestion is slower on certain days or at certain times?

Perhaps my IBS isn't reacting well to certain foods I'm eating and delaying the carbs reaching the insulin?

Is the protein affecting my digestion?

Is it the combination of what I'm eating?

So, I tried the following solutions in attempt to rule out the cause:

Reduced my Tresiba dose; no change.

Increased my Novorapid carb-to-insulin ratio to inject less insulin; sometimes it steepened the drop and increased the rise, other times the outcome didn't change.

Ate meal on different days and/or at different times; no change.

Ate chicken an hour after the carbs; no change.

Swapped out broccoli, chicken and potatoes one at a time for alternative and IBS friendly food options to rule out the culprit; no change.

At this point, I am absolutely stumped. I keep feeling like I'm doing something wrong and I'm always on edge when I have to inject. Has anyone else encountered a problem similar to this and possibly might have any other ideas of what could be causing it?

 

[EllieM]

Hmm, that is strange.

It sounds a bit like this meal is mimicing "the pizza effect" for you, but I have no idea why.

https://diatribe.org/diet-and-nutrition/pizza-and-blood-sugar-control-not-quite-easy-pie

Is it worth experimenting with splitting your insulin dose and having half at the normal time and the rest a couple of hours later? (ie doing some sort of delayed bolus?)

I suspect it would be worth having a chat with your diabetic team/endo to see if they have any helpful suggestions, and the possible relevance of the IBS.

Good luck. I would be very interested to read about any conclusions that you come to, as I occasionally have a similar issue, but am not organised enough to have identified a particular food culprit.

 

[ViktoriaM]

I agree with EllieM that it sounds like this meal is having the Pizza effect for you. A split dose could help with this. Or you could try injecting after the meal. I have a similar problem with certain types of bread. If i inject before eating or just after I finished my bloodsugar stays at the same level or drops at first and then rises a few hours later. So with this particular bread I wait until my levels start to rise and inject then.

 

[Allyee]

I wonder whether your IBS-C is having an impact here in that your gut absorption, and thus speed of the anticipated Blood Sugar rise due to carb ingestion, is slower in an evening. Because you don't eat at night (I assume!), the food eaten during the day (even with the strictest FODMAP diet) can contribute to greater inflammation and thus slower nutrient absorption throughout the day..and then your gut rests/recovers overnight. I would probably delay your insulin dose a bit so the insulin kicks in as your blood sugars rise after your meal. GO SLOW on all adjustments and I'd suggest something like 5 min increments, every 2-3 days to see where you avoid the hypos. I think you may end up with an ideal insulin dose timing maybe 15-30 mins post start of eating perhaps. Proteins do raise your BG (for people w/o IBS with would be +2 hours compared to carbs within 15mins+) so this 'peak' may also be delayed for you. Maybe reducing your IC ratio compared to other times of day and dose splitting per other commenters above might also be worthwhile to fine tune but don't do everything at once. I would work on avoiding those postpradanial hypos first. Lastly, your amount of stress which affects both your diabetes and IBS will vary - no 2 days will be exactly the same - so maybe aim for a most days approach rather than not having the odd day where things don't go to plan. Hope this helps a bit.

 

[lessci]

I'd agree with @EllieM and @ViktoriaM that it's the "pizza effect" and the fat in the roast potatoes that are slowing the carb absorption - as a type 2 I have no idea how you would combat that with your insulin dosage, but I'm sure that there are much more knowledgeable folk than I here